PROJECT SUMMARY American Indians and Alaska Natives (AIs/ANs) and U.S.-born Hispanic Americans (HAs) have a heavier burden of kidney cancer than non-Hispanic Whites (NHWs). They often have multiple barriers to health care, and they are often diagnosed with more advanced stage kidney cancer. Early detection and timely surgical treatment with a minimally invasive surgical method likely reduce kidney cancer health disparities. However, kidney cancer health disparities research focuses on differences in clinical characteristics between NHWs and non-Hispanic Blacks often using national-level data ignoring heterogeneity across U.S. regions or subpopulations. AIs/ANs and HAs are underrepresented in kidney cancer clinical studies, and risk factors for diagnosis with advanced stage kidney cancer and mortality among these racial/ethnic groups are not well understood. Moreover, there is no qualitative study in AIs/ANs and HAs to identify factors that affect surgical treatment that AI/AN and HA patients receive and if they are contributing to high mortality. The goal of this study is to identify causes of kidney cancer surgical disparities using a mixed method approach combining semi-structured in-depth interviews and analysis of clinical data at local-, state-, and national-levels using data from Banner University Medical Center, Arizona Cancer Registry, and the National Cancer Database. We hypothesize that compared to NHWs, AIs and HAs have poor understanding of cancer and kidney cancer symptoms and experience more barriers in health care which results in advanced stage cancer diagnosis, delay of care, delivery of less optimal treatments, and ultimately poorer survival. Qualitative and quantitative methods will be used respectively in Specific Aims (SA) 1 and 2 to explore how differently that AIs and HAs or HA subgroups experience the kidney cancer surgical disparities. To identify knowledge gaps in kidney cancer secondary and tertiary prevention and barriers to care, one-hour semi-structured in- depth interviews will be conducted to assess understanding of kidney cancer symptoms, diagnosis, care, and social determinants of health with kidney cancer patients (n=50), individuals without cancer in community settings (n=50), and community urologists and health care providers (n=10) in minority servicing primary care clinics (SA 1). Differences in clinical characteristics at diagnosis and types and timing of surgical care received between AI, HA patients and NHW patients will be determined, and then associations between these differences and overall survival will be assessed (SA2). The results from SA1 and SA2 will be integrated to develop a theory of kidney cancer surgical disparities. Our long-term goal is to develop intervention studies to improve kidney cancer care in racial/ethnic minority groups with a heavy kidney cancer burden. This study will identify specific areas to focus on to reduce knowledge gaps and barriers to care and develop a theory on kidney cancer surgical disparities to be tested. Culturally-adapted materials will be developed to educate AI/AN and HA patients in clinical settings.